My name is Steven Charlap, MD and I have solutions, but first let’s review what contributes to obesity. Obesity is the result of many factors of which any combination may be in play for an individual. On the clinical front, obesity may be the result of slowing of one’s metabolism due to such factors as insufficient thyroid hormone or an overabundant release of cortisol, a natural steroid that causes retention of water among other issues. Aging past 50 years old also can contribute as our metabolism, hormones, and digestive capabilities begin to lose certain functionality.
Depression can also be a major cause of obesity. For some, other psychosocial issues may lead to obesity being the solution to a problem rather than the problem itself. For example, a recent study demonstrated a linear correlation between adverse childhood events, such as abuse or lose of parent before the age of ten, and unhealthy behaviors. Early childhood abuse can result in the gaining of weight as a protective shield of sorts. Identifying the root cause of one’s obesity is more important than rushing to judgment.
Other causes of obesity include simply eating too much food. I am not referring to consuming too many fruits and vegetables; rather, I refer to unfettered access to foods that contain large amounts of processed sugar and flour. Fried foods high in saturated fats and any food containing trans-fats are among the guilty as well. The time of day food is consumed also makes a difference. Evolutionarily, when man did not eat during the first part of the day, the body assumed that food was in short supply and slowed down metabolism to retain as much of any food consumed later in the day. Also, the lack of food results in the release of neuro-hormones such as leptin and ghrelin. Leptin is an appetite stimulant that is activated after no intake of foot for a while eating and ghrelin, an appetite suppressant, is repressed under the same circumstances. Therefore, when a person finally eats, the stage is set for them to overeat and in particular crave foods with a high sugar content. This same hormonal process goes into effect when a person does not get enough sleep and so inadequate sleep, typically less than 7 uninterrupted hours, may also contribute to obesity.
In his recent book Willpower, Robert Baumeister states that decreased blood sugar levels contribute to depleted neurotransmitters leading to poor decision-making. Exhausted capacity for decision-making leads to bad food choices later in the day, often including fast-food takeaways. It is claimed that sumo wrestlers gain their enormous girth by starving themselves all day, then consuming heavy fats and carbohydrates dinners and then immediately going to bed. Although I am unaware of any scientific evidence for this anecdote, it is consistent with what happens when one does not eat all day and overeats at dinner.
For some people the cause of their obesity may be that they just love food so much that unlike their European counterparts who are said to eat to live, these individuals simply live to eat. Finally, some obese individuals and this is particularly true for children, have little choice but to consume obesigenic foods because their parents either are ignorant regarding the consequences of such diets, misinformed to believe that they can only afford to offer such unhealthy foods, or are hard-pressed for time to prepare healthy meals. Of course, schools offering similar fare such as pizza and French fries are major contributors to the problem as well. In fact, last week, some congressman tried to keep pizza on school menus claiming that the tomato sauce used to make the pizza qualified it as a vegetable. The french fries won as potatoes.
Finally, food and supplement marketers, media reporting of inconclusive and mostly observational studies, coupled with well-intentioned but misguided populist bromides coming forth from media personalities like Dr. Oz, has completely confused the American population. For example, last week I spoke to a Medicare patient who came in fro her 100% covered Annual Wellness Visit. As part of her visit, I reviewed her supplements and vitamins. They included Milk Thistle to promote liver health because she heard Dr. Oz say so. I suggested otherwise since she had no known liver disease. A bottle labeled sleeping pills was actually contained diphenhydramine, an ant--histamine typically used to control cold and allergy symptoms. In addition, she was taking Vitamin D and calcium from three different sources with risks of potential toxicity. Many similar patients have never had a good resource to identify what supplements if any, they really need. In a recent Time Magazine article, John Cloud did his own social science experiment by taking some 3000 supplements over a 5 month period, gaining over ten pounds because of what he calls the “licensing effect,” a misguided belief that while on pills he had the license to eat unhealthy and weight contributing foods.
So what is America to do under the weight of this problem? The answer is obviously not simplistic or solutions would have been widely implemented already.
As the United States Preventive Services Task Force recommends, the first step is medical evaluation by a primary care practitioner to rule out an underlying clinical condition as the potential root cause of the obesity. Secondly, I recommend a consultation with a psychologist to rule out any psychosocial reasons for the excessive weight. If the trained professionals do not identify any medical or psychosocial reasons for the problem, then I recommend consultation with a registered dietitian and exercise physiologist to develop a nutrition as well as exercise plan. In addition to private consultations, I firmly believe that group sessions are critical to achieving meaningful weight loss. The dynamics of group interaction and peer pressure, as well as a nurturing, non-judgmental, and supportive environment provide the critical and practical information needed to change one’s lifestyle and achieve improved health and weight loss is a clinically proven approach.
As referenced earlier, for Medicare beneficiaries, there is great news because Medicare now covers weight loss counseling by a primary care practitioner in a primary care setting at no cost to the qualified beneficiary. It is hoped that other insurances will follow Medicare’s lead and implement such coverage in the near future.
So if you have Medicare and need to lose weight, MDPrevent can help. If you don’t have Medicare, we have a similar program offered at an affordable price. We call our clinically proven program LEAN (Lifestyle Education And Nutrition) Weight Loss. Our program was developed off a very successful program developed by the Veterans Health Administration which we enhanced. Our team of Preventioneers, so called because we are pioneering new approaches to prevention includes MDs, nurse practitioners, health psychologists,nutritionists/
So if you are interested in learning how you can improve your health, take control of your weight, and live a more fulfilling life, call us today at (561) 807-2561 or visit us at www.mdprevent.net .
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